Healthcare Provider Details

I. General information

NPI: 1851577183
Provider Name (Legal Business Name): CHARLES LOUIS PERKINS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 09/26/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 W NEWBERRY RD
GAINESVILLE FL
32605-6621
US

IV. Provider business mailing address

NORTH FLORIDA RADIATION ONCOLOGY LLC 6420 W NEWBERRY RD
GAINESVILLE FL
32605-4308
US

V. Phone/Fax

Practice location:
  • Phone: 352-333-5840
  • Fax: 352-333-5841
Mailing address:
  • Phone: 352-333-5840
  • Fax: 352-333-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number061319
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME105206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: